Neuroprotective effects of early antiretrovirals in vertical HIV infection.

We performed a retrospective study of a series of 58 of 189 vertically HIV-1 infected children who went on to develop progressive HIV-1-associated encephalopathy to assess real-life effects of early antiretroviral therapy on neurologic outcome. Our findings clearly indicate that antiretroviral therapy before the onset of neurologic symptoms delayed presentation of progressive HIV-1-associated encephalopathy, with an additional beneficial effect on survival.

Chronic obstructive pulmonary disease as a cardiovascular risk factor. Results of a case-control study (CONSISTE study).

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) patients present a high prevalence of cardiovascular disease. This excess of comorbidity could be related to a common pathogenic mechanism, but it could also be explained by the existence of common risk factors. The objective of this study was to determine whether COPD patients present greater cardiovascular comorbidity than control subjects and whether COPD can be considered a risk factor per se. METHODS: 1200 COPD patients and 300 control subjects were recruited for this multicenter, cross-sectional, case-control study. RESULTS: Compared with the control group, the COPD group showed a significantly higher prevalence of ischemic heart disease (12.5% versus 4.7%; P < 0.0001), cerebrovascular disease (10% versus 2%; P < 0.0001), and peripheral vascular disease (16.4% versus 4.1%; P < 0.001). In the univariate risk analysis, COPD, hypertension, diabetes, obesity, and dyslipidemia were risk factors for ischemic heart disease. In the multivariate analysis adjusted for the remaining factors, COPD was still an independent risk factor (odds ratio: 2.23; 95% confidence interval: 1.18-4.24; P = 0.014). CONCLUSION: COPD patients show a high prevalence of cardiovascular disease, higher than expected given their age and the coexistence of classic cardiovascular risk factors.

Determinants and predictors of the cost of COPD in primary care: a Spanish perspective.

OBJECTIVES: 1) To estimate the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) followed in primary care in Spain; 2) To analyze the possible cost predictor variables. PATIENTS AND METHODS: A multicenter, epidemiological, observational, descriptive study. Sociodemographic data, severity of disease, associated comorbidity, treatment followed by patients, quality of life (SF-12 questionnaire), health care resource utilization in the previous 12 months and duration of working disability due to COPD were collected. RESULTS: A total of 10,711 patients (75.6% men; 24.4% women) with a mean age of 67.1 +/- 9.66 years were evaluated. The mean forced expiratory volume in one second (FEV1) value was 57.4 +/- 13.4%. The total cost per patient per year was Euro1,922.60 +/- 2,306.44. The largest component of this cost was hospitalization (Euro788.72 +/- 1,766.65), followed by cost of drugs (Euro492.87 +/- 412.15) and visits to emergency rooms (Euro134.32 +/- 195.44). Linear regression analysis found associated heart disease, FEV1, physical component of quality of life, number of medical visits (primary care physician, pneumologist and emergency room), hospital admissions (frequency and duration of stay) and duration of working disability to be significant predictors of the total annual cost. CONCLUSIONS: The total annual cost of a COPD patient followed in primary care in Spain was considered high in this study. The presence of associated heart disease, severity of airflow obstruction, physical component of quality of life, health care resource utilization and duration of work disability were found to be predictor of cost.